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Because of confidentiality issues of torture survivors (e.g., everyone in their focus group
could assume most others were sexually tortured), differences in language capacity and
culture, and fear of discovery, it was decided a face-to-face focus group was not viable.
Instead, a series of questions was asked by phone interview that allowed staff conclusions
on 1) current problems or concerns, 2) potential barriers to solving concerns or problems,
3) clients’existing strengths, 4) clients’ views of potential solutions or strategies.

The survey included 12 clients from 9 countries. Of these, 7 were female and 5 male,
most in the 25 to 55 age range.

Mental health services sought were psychiatry, psychotherapy, and psychological
evaluation. Most sought multiple services at once; all 12 registered strong satisfaction
with services even when some issues were unresolved (e.g., seizures, political asylum).

6 used psychiatry for medication
12 used psychotherapy
8 used psychological assessment/testing for political asylum appeals

   1. Current problems or concerns

On first assessment, clients’ concerns were with strong experience of typical symptoms
from torture, especially: profound depression, flashbacks, sleep disorders, anger, bad
family relations, anxiety, suicidal inclination, difficulty concentrating and remembering,
grief, and terror. In addition, over half did not know if they would be granted political
asylum, and so were anxious about deportation to torture or death.

After varying periods of successful rehabilitation, clients’ current experience of these
problems is either that they are resolved (half the asylum applicants got asylum), or are
under control from psychotherapy and/or psychiatry received or still continuing. In
addition, while a number understand problems from symptoms may be indefinite, they
have recovered enough to find aids to add to clinical sources helping them—reconnecting
with family, obtaining legal status for a job, etc.

   2. Potential barriers to solving those problems

A significant barrier is retraumatization—having a traumatic experience or an experience
they relate to the trauma of torture will cause the symptoms to rise in strength and
number. News of war and torture in Iraq and Afghanistan, the terrorist attacks of 9/11,
living in an unsafe neighborhood because of low income, being threatened with
deportation or loss of welfare benefits have all retraumatized these clients. The degree
and number of rising symptoms have varied in each.

Lack of English, sometimes due to the trauma symptoms of difficulty concentrating,
remembering, or depression, can make finding or holding jobs, getting citizenship and
related benefits, or getting medical care difficult or impossible. These events have kept
psychological symptoms and resultant disability higher for some.

Lack of income, housing, food, medical care, or other persons in their lives (friends,
family, neighbors) have kept some from more complete symptom relief—and in need of
mental health services for strength, information, and insight while these practical issues
are dealt with.

Lack of medical care from lack of insurance, or of public transportation, or of cost of
psychiatric medication and/or private psychotherapy, or of knowledgeable regular care
outside of emergency service are perceived as barriers to continued symptom control.

In summary, anything that is perceived as a threat to life or safety retraumatizes, and
though these clients have found both relief and control in The Center’s services, they
appear to have continuing susceptibility to felt problems (except granted asylum).
However, while they report these problems in the survey, few now actively call The
Center’s services.

   3. Clients’ existing strengths

The will to stay alive, and to live a better life;
The ability to revive trust in other people;
Family commitments and responsibilities;
Ability to survive on very few resources;
Understanding that special rehabilitation services are available to torture survivors;
Ability to understand and control symptoms if services and/or life reasonable life
conditions (safety) are available

   4. Clients’ views of potential solutions or strategies

For resolution or dealing with mental health problems, clients understand that in a crisis
they can approach The Center at any time to resume help; that apparently provides a
secure basis for getting on with other solutions.

This is followed by a learning about, and how to use, public medical insurance and/or
publicly available mental health facilities—facilitated either by learning English, or by
acquiring family and community help in interpreting. They understand trauma symptoms
must first, or simultaneously, be overcome in order to learn important new skills.
In some cases, relying on The Center to provide psychological evaluations to assist in
obtaining public benefits to which they are potentially entitled in income and/or medical

Clients attempt to control stress and repress symptoms by obtaining work, and the legal
documents allowing work. Then by working very hard, by way of distraction.